Registration for Weekend Cancer Retreat Programs:

Healing Odyssey has provided a secure form to register for the three day cancer retreat program.
Thank you for your interest in the Retreat. Prior to registering online and paying your registration, please read the following information that is important for your understanding of the retreat.

HO 51 Friday – Sunday April 20-22, 2018

Time: Program begins Friday afternoon and ends at 3 PM Sunday.

Location: Pali Mountain Retreat, Running Springs, CA

Fee: FEES HAVE BEEN WAIVED FOR2018. Weekend includes lodging, all meals and snacks, Ropes Course, and educational materials, a $100 non-refundable registration fee is due at time of registration. (Please call us if you cannot afford the $100 fee.)

Cancellation: The $100 registration fee is non refundable.

Transportation: Healing Odyssey is not responsible for transportation. Carpooling is encouraged.

Transportation is the responsibility of each participant. Carpooling may be possible. We will assist by giving you information on area drivers.

Thank you for your interest in the Retreat. Prior to registering online and paying your registration fee, please read the following information that is important for your understanding of the retreat.

Medical considerations:

The retreat site is at 6000 ft. elevation and Saturday is spent mostly outdoors. Please assess your current health condition and ability to fully participate. You must be able to walk unassisted in a wooded area. If you have any breathing issues, please discuss this with us ahead of time.

Healing Odyssey is an active, participatory retreat. If you are not sufficiently recovered from surgery and/or active treatment by the date of the retreat, you may wish to register at a later time so that you can enjoy yourself and fully participate in all programs.

Please do not attend if you have any communicable diseases.

Please make sure that your immune system function is adequate to be in a group of 40 women.

Meals are served cafeteria style in a large dining room with the possibility of other large groups. The food is plentiful and freshly made daily. There are vegetarian, vegan and gluten free options which we must pre-order three weeks prior to the retreat.

A current medical release is required of all campers and must be received three weeks prior to the retreat. It will be mailed to you after you register.

Other considerations:

Healing Odyssey retreats are custom designed for women cancer survivors over the age of 18.

The retreat is most helpful to survivors within the first 5 years of recovery or to those with ongoing challenges caused by their cancer.

Campers must be capable of getting themselves to and from Running Springs, CA by Friday at 1 pm and plan to attend the program until 3 pm on Sunday. Transportation is the responsibility of each camper. We will make an effort to assist with car pools but all campers should have a backup plan, as things can happen with a driver at the last minute.

Healing Odyssey is open to out of area participants. However, it is strongly advised that if you are flying in for the retreat, that you plan to be in Southern California the day before the retreat. Air transportation issues are not uncommon and could result in your missing the retreat.

Sleeping accommodations at camp are rustic. Campers will be in cabins with 6 bunk beds. You will have a lower bunk and share the room with 5-6 other campers. Cabins are heated and have 2 shared indoor bathrooms with warm showers. Campers must be mindful that a snoring roommate is a real possibility. Be prepared with earphones or ear plugs.

All bedding must be brought by campers. However, a bedding package (pillow, blanket, sheets and a towel) is available for rental from the camp for $25. Bedding reservations must be made and paid for three weeks prior to the retreat.

The registration form must be filled out online. This helps us to know more about you and any special needs. If you have issues filling out the online registration form, please call our office and we will email or mail you the form.

Important information regarding your good faith commitments:

Your mandatory $100 registration fee is non- refundable.

Each each registration fee applies only to the retreat you are registering for.

If you need to cancel for any reason after 3/20/18 and you want to attend a future retreat, you will need to pay $300 for the future retreat unless we are able to replace you from a waiting list. This fee covers out of pocket expenses incurred by Healing Odyssey because of your cancellation.

Healing Odyssey retreats fill up very quickly. Please, if you feel that you need to cancel for any reason, notify us as soon as possible. We will be placing women on a waiting list and they will be anxiously waiting to come. Please be considerate of Healing Odyssey and your fellow survivors.

Please carefully consider all of this information. We want you to be fully informed and come to the retreat ready for a fun filled experience of a lifetime!!

By submitting this form I give permission for the information to be used by retreat and administrative staff to provide for my needs. I give permission for my demographic data to be used to measure outcomes for funding and outreach purposes.

Please call the HO office to discuss any of these guidelines or your specific situation.

Warmest regards,

Donna Farris, LCSW, Retreat Leader 949-707-1710

Event Registration

Required field must be checked before submitting form*

I have read and understand the considerations above.*

Select Retreat*

Name

FirstLast

Age

Birthdate

Ethnicity

Select T-Shirt Size

S

M

L

XL

XXL

Home Phone

Cell Phone

Work Phone

Best number to reach you in the daytime

Home

Cell

Work

Address

Street AddressAddress Line 2CityStateZIP Code

Email:

Enter EmailConfirm Email

Occupation (Current or Previous)

Work

Full time

Part time

Unemployed

Retired

Marital Status

Single

Married

Divorced

Widowed

Committed Relationship

Children?

Yes

No

How many?

Ages

Emergency Contact Name:

Phone

Relationship

Date of cancer diagnosis

Type of Cancer

Surgery?

Yes

No

Chemotherapy?

Yes

No

Radiation?

Yes

No

Date of completion of treatment

If Breast Cancer: Reconstruction?

Yes

No

Completed?

Yes

No

When Completed?

Are you facing any other physical or emotional health challenges currently? If so, please describe:

Are you taking medications related to cancer treatment or other conditions? If so please list:

What other challenges have you faced in your recovery?

Have you experienced any other major life events that are affecting you now?

What goals/expectations do you have for the Healing Odyssey retreat?

Do you have any dietary restrictions (Vegetarian, other)?

Do you have any special requests or concerns?

Transportation is the responsibility of each participant. Carpooling may be possible. We will assist by giving your information on area drivers

Are you planning to carpool?

Yes

No

Arrangements already made with

Are you able to drive anyone?

Yes

No

How many people can you take?

(Just prior to the retreat, we will share names and phone numbers of women in your area. Your carpool group will then finalize arrangements between yourselves).

How, or from whom, did you learn of Healing Odyssey? Please be specific.

For example , the name and location if a support group

His/her name and address if a Professional

Other contact?

Please Note: The phone number for Pali Retreat is 909-867-5743. CELL PHONE COVERAGE IS AVAILABLE THROUGHOUT THE CAMP.